Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: Initial experience from the Medical College of Wisconsin

Christians, Kathleen K.; Riggle, Kevin M.; Keim, Rebecca; Pappas, Sam G.; Tsai, Susan; Ritch, Paul S.; Erickson, Beth; Evans, Douglas B.

doi:10.1016/j.surg.2012.11.019

Cited by 45 publications

(21 citation statements)

References 10 publications

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“…It has also been suggested that SV–IMV anastomosis or preservation of a natural SV–IMV confluence provides sufficient venous drainage of the spleen and gastric remnant. Routine construction of a direct shunt between the SV and the left renal vein when the natural SV–IMV confluence cannot be preserved has also been reported. However, these studies did not examine the cause of sinistral portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…When a tumour infiltrates the PV–SMV confluence, the splenic vein (SV) is sometimes ligated during PD with vascular resection to achieve a margin‐negative resection. However, SV ligation may result in sinistral (left‐sided) portal hypertension and gastrointestinal bleeding. Some authors have recommended reimplantation of the SV (SV–SMV anastomosis), whereas others have reported that an SV–inferior mesenteric vein (IMV) anastomosis or preservation of a natural SV–IMV confluence may provide sufficient venous drainage of the spleen and gastric remnant.…”

Section: Introductionmentioning

confidence: 99%

“…Misuta and colleagues examined the direction of splenic venous flow in 29 patients who underwent PD with SV ligation, and decided to reconstruct an SV–IMV or SV–SMV anastomosis. Use of a temporary mesocaval shunt with a distal splenorenal shunt may facilitate segmental resection of the PV–SMV confluence during PD complicated by cavernous transformation of the PV. In contrast, other authors have reported that it is safe to divide the SV.…”

Section: Introductionmentioning

confidence: 99%

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Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation

Matsueda

Koga

et al. 2014

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation

Matsueda

Koga

et al. 2014

British Journal of Surgery

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“…There is also a report that the simultaneous resection of the splenic artery can prevent the occurrence of varices due to LPH, but in this case, there was a risk of severe complications such as splenic infarction and residual gastric blood flow disorder [7]. On the other hand, there are reports that SpV-PV anastomosis is useful for preventing gastrointestinal bleeding [8], and a systemic shunt by SpV-left renal vein anastomosis is useful [9] when SpV reconstruction is necessary. Theoretically, SpV-inferior vena cava anastomosis is also conceivable, but the evidence is limited.…”

Section: Discussionmentioning

confidence: 91%

Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

et al. 2020

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Background: Pancreatoduodenectomy with resection of the portal vein or superior mesenteric vein confluence has been safely performed in patients with pancreatic head cancer associated with infiltration of the portal vein or superior mesenteric vein. In recent years, left-sided portal hypertension, a late postoperative complication, has received focus owing to increased long-term survival with advances in chemotherapy. Left-sided hypertension may sometimes cause fatal gastrointestinal bleeding because of the rupture of gastrointestinal varices. Here, we present a case of colonic varices caused by left-sided portal hypertension after pancreatoduodenectomy with portal vein resection. Case presentation: A 69-year-old man diagnosed with pancreatic head cancer was referred to our department for surgery after undergoing chemotherapy with nine courses of gemcitabine and nab-paclitaxel. Computed tomography showed a mass 25 mm in diameter and in contact with the portal vein. He had undergone subtotal stomachpreserving pancreatoduodenectomy with portal vein resection. Four centimeters of the portal vein had been resected, and end-to-end anastomosis was performed without splenic vein reconstruction. We had to completely resect the right colic vein, accessary right colic vein, and middle colic vein due to tumor invasion. The pathological diagnosis was ypT3, ypN1a, ypM0, and ypStageIIB, and he was administered TS-1 as postoperative adjuvant chemotherapy. Seven months after therapeutic radical surgery, he presented with melena with progressive anemia. Computed tomography revealed transverse colonic varices. He was offered interventional radiology. Trans-splenic arterial splenic venography showed that transverse colonic varices had developed as collateral circulation of the splenic vein and inferior mesenteric vein system. An embolic substance was injected into the transverse colonic varices, which halted the progression of the anemia caused by melena. Fifteen months after therapeutic radical surgery, local recurrence of the tumor occurred; he died 28 months after the surgery. Conclusions: When subtotal stomach-preserving pancreatoduodenectomy with portal vein resection is performed without splenic vein reconstruction, colonic varices may result from left-sided portal hypertension. Interventional radiology is an effective treatment for gastrointestinal bleeding due to colonic varices, but it is important to be observant for colonic necrosis and new varices.

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“…In the absence of a mechanism for splenic vein decompression, the patient is at risk for sinistral portal hypertension and gastrointestinal varices. In these circumstances, we create a splenorenal shunt with an end-to-side anastomosis between the splenic vein and the left renal vein 6, 7. This shunt is of particular importance in RYGB patients where the short gastric veins have been previously divided.…”

Section: Introductionmentioning

confidence: 99%

A Novel Reconstruction Technique During Pancreaticoduodenectomy After Roux-En-Y Gastric Bypass: How I do It

Younan

Tsai

Evans

et al. 2017

Journal of Gastrointestinal Surgery

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The altered anatomy in patients after bariatric surgery who have undergone a Roux-en-Y gastric bypass may pose a technical challenge for surgical removal of the pancreatic head. We treat patients with pancreas cancer with multimodality therapy in a neoadjuvant fashion followed by pancreaticoduodenectomy (PD). In patients with Roux-en-Y gastric bypass anatomy, the gastric remnant is preserved and used for pancreaticogastrostomy reconstruction and subsequently drained by the same jejunal limb used for the hepaticojejunostomy. This method of reconstruction takes advantage of the previous surgically altered anatomy and avoids the morbidity of a gastric remnant resection at the time of PD.

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Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: Initial experience from the Medical College of Wisconsin

Cited by 45 publications

References 10 publications

Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation

Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation

Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

A Novel Reconstruction Technique During Pancreaticoduodenectomy After Roux-En-Y Gastric Bypass: How I do It

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